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Fakomorphic glaucoma

 
, medical expert
Last reviewed: 11.04.2020
 
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Facomorphic glaucoma develops with the secondary closure of a corner, mature or overripe cataract. Its difference from previous pathologies lies in the swelling of the lens, shallow anterior chamber and closed corner.

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Pathophysiology

Facomorphic glaucoma is a direct complication of a mature or overripe cataract with lens swelling, displacement of the structures of the anterior segment of the anterior. At an early stage, the rise in intraocular pressure leads to the pupillary block. Further, the increasing in size lens displaces anteriorly the peripheral part of the iris, blocking the outflow of aqueous humor through the trabecular meshwork. Facomorphic glaucoma is common in developing countries where surgical cataract extraction is delayed. The prognosis for vision is poor: according to one study, only 57% of 49 patients with phacomorphic glaucoma had visual acuity of 0.5 or more.

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Symptoms of phacomorphic glaucoma

Patients observe a gradual or sharp decrease in vision, pain in the eye, headache, and photophobia.

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Clinical examination

The main problem is a mature or overripe cataract with a shallow anterior chamber. The pupil may be in a state of average mydriasis, with or without iris bombing, with gonioscopy, the angle is closed. Due to obstruction of the aqueous outflow, intraglaze pressure is increased, corneal edema is possible.

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Treatment of phacomorphic glaucoma

The primary treatment is medical therapy to suppress the secretion of intraocular fluid. Miotiki can increase the contact between the lens and the iris. Therefore they should not be used. To reduce the pupillary block, laser iridotomy should be performed. Iridotomy opens the anterior chamber angle, reduces intraocular pressure, and helps reduce the activity of the process before cataract extraction. In addition, with its help, the doctor may examine the anterior chamber angle for front synechiae. The degree of scarring in the corner indicates the need for antiglaucomatous surgery, which is carried out simultaneously or separately from cataract extraction. The final treatment for phacomorphic glaucoma is removal of the swollen lens. Dyeing the front capsule with indocyanin green makes it easier to break the capsule on the dense lens.

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